Severe Pleuropulmonary Paragonimiasis Caused by Paragonimus mexicanus Treated as Tuberculosis in Ecuador

Abstract

A 30-year-old male, from a subtropical region of Ecuador, was hospitalized with a 5-year history of persistent cough with rusty brown sputum, chest pain, and progressive dyspnea. The patient underwent thoracic surgery 3 years ago for pleural effusion and subsequently received a 9-month regimen treatment of tuberculosis. However, there was no clinical resolution and symptoms became progressively worse. A chest radiograph and computerized tomography scan showed several small nodules in both lungs. Eggs of Paragonimus spp. were observed in sputum smears, but the smears were negative for acid-fast bacilli. Molecular characterization of eggs by the internal transcribed spacer-2 regions identified them as Paragonimus mexicanus The patient was treated with praziquantel and tested negative parasitologically for 12 months. There was clinical resolution of the cough and expectoration, but dyspnea and chest pain persisted.

Hypolobocera guayaquilensis (Decapoda: Pseudothelphusidae): A New Crab Intermediate Host of Paragonimus mexicanus in Manabí Province, Ecuador

“…The sequence analysis of the PCR amplicons revealed that the amplified product was 461 bp (without primer sequences). The sequences obtained were identical to those previously obtained P. mexicanus metacercariae (DDBJ/EMBL/GenBank accession number: AB308377) and eggs (AB308378) occurring in Ecuador [ 14 ]. Therefore, the nucleotide sequence obtained in this study has been deposited as the metacercarial stage of P. mexicanus in the DDBJ/EMBL/GenBank database under the accession number LC317061.…”

Pleural lump after paragonimiasis treated by thoracoscopy: A case report

“…However, the clinical findings in paragonimiasis may resemble those of pleu-ropulmonary tuberculosis (TB), pneumonia, bronchitis, or bronchiectasis. Several studies reported paragonimiasis mimicking TB and the cases were misdiagnosed and treated as TB[ 7 , 8 ]. The mass in the pleural cavity that forms after standard treatment as our case can also lead to a misdiagnosis as malignant lesions.…”

Pulmonary Paragonimiasis in Native Community, Esmeraldas Province, Ecuador, 2022

“…Symptoms include fever and respiratory involvement, and most persons have a productive cough with rusty sputum or chest pain that can last from a few months to years. Thus, tuberculosis is the main condition to be ruled out in differential diagnosis (6,7). We report a public health intervention for a cluster of paragonimiasis observed during the end of 2021-May 2022, in San Lorenzo, Ecuador.…”

“…The main trematode species known to cause paragonimiasis in Ecuador is P. mexicanus, although molecular characterization has not been performed extensively. Thus, information about circulating species might be incomplete (5,6).…”